Healthcare Provider Details

I. General information

NPI: 1871125039
Provider Name (Legal Business Name): STEPHANIE GRZYCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE A WILSON

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

15 SWALES FARM RD
PLYMOUTH MA
02360-2986
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone: 508-273-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN02259
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: